| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 13784 NEWARK, NJ 07188 | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | $62K | — | $62K | 3.96% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 12505 PARK POTOMAC AVE STE 300 POTOMAC, MD 20854 | KAISER FOUNDATION HEALTH PLAN, INC. | $28K | — | $28K | 2.93% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | PO BOX 31817 CHARLOTTE, NC 28231 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | $52K | — | $52K | 6.80% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 7733 FORSYTH BLVD STE 1350 SAINT LOUIS, MO 63105 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $8K | $8K | 0.99% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON MIDWEST | 7733 FORSYTH BLVD STE 1350 SAINT LOUIS, MO 63105 | LINCOLN NATIONAL LIFE INSURANCE COMPANY | — | $4K | $4K | 0.98% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | 29754 NETWORK PL CHICAGO, IL 60673 | VISION SERVICE PLAN | $29K | — | $29K | 10.77% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTH | 29754 NETWORK PLACE CHICAGO, IL 60673 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NY | $18K | — | $18K | 8.54% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTH | 29754 NETWORK PLACE CHICAGO, IL 60673 | NEW YORK LIFE GROUP INSURANCE COMPANY OF NY | $17K | — | $17K | 8.54% |
| GREG I HINRICHS3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $8K | $11K | $19K | 18.53% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | PO BOX 905554 CHARLOTTE, NC 28290 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $8K | $2K | $10K | 10.37% |
| DANIEL WARD RICHARDSON3 | 11525 N COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $4K | — | $4K | 4.01% |
| JAMES WILLIAM DEUINK3 | 11525 N. COMMUNITY HOUSE RD STE 450 CHARLOTTE, NC 28277 | PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY | $4K | — | $4K | 3.84% |
| AFFINITY LTC, LLC3 | 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $4K | — | $4K | 8.65% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST | 29754 NETWORK PL SUITE 2500 CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $1K | — | $1K | 2.33% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 29754 NETWORK PL CHICAGO, IL 60673 | METLIFE LEGAL PLANS | $2K | $42 | $2K | 6.23% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST, INC | 214 N TRYON STREET SUITE 2500 CHARLOTTE, NC 28202 | METLIFE LEGAL PLANS | $1K | — | $1K | 3.42% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF TENNESSEE | 29982 NETWORK PLACE CHICAGO, IL 60673 | METLIFE LEGAL PLANS | — | $695 | $695 | 1.81% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS OF NORTH CAROLINA, INC. | 301 SOUTH TRYON STREET CHARLOTTE, NC 28282 | METLIFE LEGAL PLANS | — | $39 | $39 | 0.10% |
| MICHAEL S VANGAVREE3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $2K | — | $2K | 9.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $337 | — | $337 | 2.00% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTH | 29754 NETWORK PLACE CHICAGO, IL 60673 | CIGNA LIFE INSURANCE COMPANY OF NEW YORK | $3K | $41 | $3K | 20.26% |
| AFFINITY LTC, LLC3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $945 | — | $945 | 8.97% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $210 | — | $210 | 1.99% |
| MICHAEL S VANGAVREE3 | C/O LTC GLOBAL 6201 PRESIDENTIAL COURT FORT MYERS, FL 33919 | GENWORTH LIFE INSURANCE COMPANY | $309 | — | $309 | 8.24% |
| WILLIS TOWERS WATSON US LLC3 Filed as: WILLIS TOWERS WATSON SOUTHEAST INC. | 29754 NETWORK PLACE CHICAGO, IL 606731297 | GENWORTH LIFE INSURANCE COMPANY | $69 | — | $69 | 1.84% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| ANTHEM BLUE CROSS LIFE AND HEALTH I EIN 95-4331852 TPA | Claims processing; Contract Administrator; Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.) Service code 12 | — | $1.6M |
| WILLIS OF NORTH CAROLINA, INC. BROKER | Insurance agents and brokers; Insurance brokerage commissions and fees; Other commissions Service code 22 | 301 S TRYON ST SUITE 2600 CHARLOTTE, NC 28282 | $0 |
| INGENIORX, INC. EIN 82-3062245 RX REBATES AND ADMIN FEE | Float revenue; Other services; Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Claims processing Service code 12 | — | -$132K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 2,205 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 36 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 2,241 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN, INC. | 139 | $948K |
| Dental | CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES | 1,909 | $1.6M |
| Vision | VISION SERVICE PLAN | 1,584 | $269K |
| Life insurance | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,273 | $763K |
| Long-term disability(2 contracts, 2 carriers) | LINCOLN NATIONAL LIFE INSURANCE COMPANY | 2,273 | $484K |
| Other(10 contracts, 6 carriers) | NEW YORK LIFE GROUP INSURANCE COMPANY OF NY | 3,225 | $700K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 3,225 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.